How to Start and Maintain a Free Health Care Clinic

Presented by: Haakon Carlson, M.D.

How to Start and Maintain a Free Health Care Clinic

 A Need was Identified and Researched

Need Identified and Researched

The need for free health care is almost a given . . . But where to start?

Free health care in Haiti or Here at Home?

Need Identified and Researched

Reality Testing

      Sharing the Idea with Confidantes Spouse Professional colleague and friend Pastor Hospital Foundation Administrator Society of St. Vincent de Paul Administrator and two Board Members

Need Identified and Researched

     Getting Facts and Figures with Research Prairie Clinic, S.C. - the local primary family practice group (and my former group practice) Sauk Prairie Memorial Hospital & Clinics - the community hospital Society of St. Vincent de Paul - a very active social service force in the community County Public Health Nurses - Sauk, Dane (Northwest), Columbia and Iowa Statistical Publications • Federal Poverty Guidelines • Health Policy Center, The Urban Institute, Washington, DC • Wisconsin Family Health Survey, Center for Health Statistics • Division of Health, Dept. of Health and Family Services

Need Identified and Researched

How are Free Clinics Started?

National Free Clinic Foundation of America

1240 Third Street, S.W.

Roanoke, VA 24016 Phone: (540) 344-8242 Email: [email protected]

Web: www.freeclinic.net

Jane E. Zwiers, RN, Convenor Free Clinics of the Great Lakes Region

321 West South Street Kalamazoo, MI 49007 Phone: (616) 344-3751 Fax: (616) 353-4186 Email: [email protected]

Web: www.fcglr.org

Volunteers in Health Care (VIH)

Memorial Hospital of Rhode Island 111 Brewster Street Pawtucket, RI 02860 Toll Free: (877) 844-8442 Email: [email protected]

Web: www.volunteersinheatlhcare.org

John Vick, Administrator, Volunteer Health Care Program

Bureau of State Risk Management PO Box 77008 Madison, WI 53707-7008 Phone: (608) 261-6638

Jill Collier FNP, Wisconsin State Coordinator (Wisconsin Free Clinics)

Living Healthy Communicty Clinic 800 Algoma Blvd Oshkosh, WI 54901 Phone: (920) 424-1242 Fax: (920) 424-0123 Email: [email protected]

How to Start and Maintain a Free Health Care Clinic

 A Need was Identified and Researched  An Informed Community was Marshaled

An Informed Community was Marshaled

Spreading the Word     A

Public Forum

was announced through the local newspapers and by

Individual Invitations

for the presentation of plans for a free health care clinic A

Noon Meeting

was hosted by St. John’s Church in the fellowship hall and

Lunch was Catered by the Hospital

A

Slide Presentation

was given and

Volunteer Forms

were available

An Informed Community was Marshaled

An Essential Ingredient

The concept of a free health clinic has the unanimous support of the Sauk Prairie Memorial Hospital Medical Staff

An Informed Community was Marshaled

Need Assessment for a Free Clinic: The “Economically Poor” Federal Poverty Guidelines (FPG), April 1998

Source: Wisconsin Primary Health Care Association

An Informed Community was Marshaled

Percent of County Population Below FPG - 1995 Estimates

Source: Wisconsin Primary Health Care Association

An Informed Community was Marshaled

Percent of County Population Uninsured - 1994

Source: The Urban Institute, Washington, D.C.

An Informed Community was Marshaled

Percent of Wisconsin Non-Metropolitan Population Underinsured - 1996 • No insurance for part of the year - 6% • No insurance for the entire year - 7% • In 1996, 7-13% of the non-metropolitan population in Wisconsin was without adequate insurance.

Source: Wisconsin Department of Health and Family Services

An Informed Community was Marshaled

Access

What is a Free Clinic?

An easily accessible facility which provides quality, comprehensive medical care with the same dignity and confidentiality afforded to the private sector.

Confidentiality and Quality

A clinic would serve people who are trying to improve their lives but do not have medical insurance or the ability to pay for medical care. It would be an evening, walk-in health facility where working people can seek medical care without having to take time off from work during the day without pay.

An Informed Community was Marshaled

What is a Free Clinic?

Governance

A private, non-profit, autonomous facility governed by a board of directors.

Operations

A relatively cost efficient facility relying on private contributions for the majority of the operating expenses and professional volunteers to deliver medical care. A small, dedicated staff is necessary to coordinate the daily operations of the facility.

Community Support

A well organized facility which must have the support of the medical community as well as the community-at-large.

An Informed Community was Marshaled

Who Does a Free Clinic Serve?

• Patients referred from physicians, hospitals, schools, social workers, home health RN’s, clergy and others.

• Those in financial need • Minimum wage workers • People between jobs • Single parent families • People who are trying to get on their feet • Those who are working two or three jobs • Senior citizens who cannot afford medications • Those who do not have any third party coverage • Those who cannot afford private care

An Informed Community was Marshaled

Who are the Providers in a Free Clinic?

• Volunteer health care workers • Management and office staff • “People” people • Other professionals

An Informed Community was Marshaled

What are the Services Offered?

• Evaluation and treatment of acute/chronic health care problems • Health maintenance and education • Assistance for people requiring eligible health care from other providers • Eye care • Dental services • Other services

An Informed Community was Marshaled

What providers of a free clinic DO NOT do: • Admit to the hospital • Obstetrics • Encourage emergency care • Surgery • Provide second opinions • Duplicate services • Other

An Informed Community was Marshaled

Where is a Free Clinic Housed?

What are the Hours?

• Accessible site • Hospital and professional clinics • Churches • Free standing buildings • Service organizations (St. Vincent DePaul, Salvation Army) Hours based on need - possibly starting with one evening per week

An Informed Community was Marshaled

How Will the Free Clinic be Financed?

• Local Support – Hospitals & professionals – Churches – Service organizations – Private donations – Local governments – Token co-pays from those who can afford it • Grants • State and Federal aid

An Informed Community was Marshaled

Where Do We Go From Here?

• Informal, temporary steering committee selects an acting board of directors:  Made up of a small number of qualified people  Establish an executive committee with skills in organizational planning, budgeting, marketing, etc.

 Appoint a medical director, head nurse, office manager

How to Start and Maintain a Free Health Care Clinic

 A Need was Identified and Researched  An Informed Community was Marshaled  An Organization was Formed

An Organization was Formed

A Steering Committee That became, in large part the Board of Directors, was formed from the returned volunteer forms         

President Vice-president Secretary/Publicist Treasurer Medical Director Clinic Director Board Member (Attorney) Board Member (Member of Society of St. Vincent de Paul Board) Board Member (Pastor Don Wendt, St. John’s Church)

An Organization was Formed

The Clinic Became a Reality      

The Name:

The Goodneighbor Clinic of Sauk Prairie, Inc. (Incorporation of a tax exempt, not-for-profit, 501 (c) (3) corporation

The Site:

Church The Educational Unit of St. John’s Lutheran

Hours of Operation:

7:00 pm One Day per Week (Monday) 1:00 -

Equipment:

Donated by the hospital, St. Vincent de Paul and Prairie Clinic

Staffing:

All volunteer professional (MD’s, RN’s, Pharmacists, Dentists, and Optometrists) and numerous “non-medical” personnel

Support Services:

Diagnostic tests (lab and imaging) and various support needs are donated by the hospital and Prairie Clinic

An Organization was Formed

The Clinic Became a Reality  

Publicity:

An Ongoing Effort

Financial Support:

 Individuals   Service Clubs Churches   Comes From the Community Community Banks The community United Way   School Children Grants 

Future Growth:

 New Location - St. Vincent Service Center  Open two days a week

A Quote . . .

It helps, now and then, to step back and take the long view . . We plant the seed that one day will grow . . .

We lay foundation that will need further development . . .

We cannot do everything, and there is a sense of liberation in realizing that.

This enables us to do something, and do it very well.

It may be incomplete, but it’s a beginning.

Oscar Romero

• www.goodneighborclinic.org

3A Determining Cost Savings to Hospitals James Walton, DO & Adam Chabira, MHA

Charity Clinic Outcomes:

Determining Impact on Hospitals

Jim Walton, DO Adam Chabira, MHA

Baylor Health Care System – Dallas, TX

Introductions

Jim Walton, DO – VP and Chief Health Equity Officer – Baylor Health Care System – Dallas, TX Adam Chabira, MHA – Program Manager – Office of Health Equity – Baylor Health Care System

Purpose of Presentation

• Discuss the importance of outcomes reporting • Present analysis methodologies for hospital impact – Key indicators/variables • Present examples of hospital impact analyses • Discuss strategies for collecting and analyzing hospital data

Data Collection: Metrics vs. Impact/Outcomes

• Metrics – Quantitative – Answer the Questions: • How many?

• How much?

– Examples: • # of visits • # of unduplicated pts.

• # of Rx’s dispensed • Impact/Outcomes – Qualitative or Quantitative – Answer the Questions: • What difference are we making?

• How are we impacting our community?

– Examples: • Improved health of pts.

• Reduction in unnecessary hospital use

The Importance of Impact/Outcomes

Outcomes are important to: – Your Boss/Board of Directors – Funders – Potential Partners – Policy Makers They tell the story of your work – How you’re impacting lives – How you’re impacting the community

Charity Clinic Impact on Hospitals

Fundamental Principles: – Providing primary and preventive care to patients will reduce dependence on hospitals for obtaining care – When patients do require hospitalization the severity/complexity of their conditions will be lower because they are receiving primary care

How do we Demonstrate Impact on Hospitals?

Show a reduction in the following Key Indicators: • Utilization – ED Visits – Admissions – Outpatient Visits – Average Length of Stay (ALOS) • Costs – Total Costs – Direct Costs – Indirect Costs

How do we Demonstrate Impact on Hospitals?

Two methodologies: – Before & After Analysis – compares hospital utilization and costs before and after enrollment in an intervention – Comparison of 2 populations – compares the hospital utilization and costs between a population receiving an intervention and a similar population not receiving the intervention

Project Access Dallas

Before & After Analysis

Project Access Dallas Impact Baylor University Medical Center ED-Related Utilization (n=87)

120 100 80 60 40 20 0 105 82 Total ED Related Visits 44 66 ED Visits 61 16 ED Admits 1 Year Before Enrollment in PAD 1 Year After Enrollment in PAD

Before & After Analysis (cont.)

Project Access Dallas Impact Baylor University Medical Center ED-Related Utilization (n=87)

∆ = -22% 1.40

1.20

1.00

0.80

0.60

0.40

0.20

0.00

1.21

0.94

Total ED-Related Visits per Patient ∆ = +50% 0.51

0.76

ED Visits per Patient 1 Year Before Enrollment in PAD 0.70

∆ = -74% 0.18

ED Admits per Patient 1 Year After Enrollment in PAD

Before & After Analysis (cont.)

Project Access Dallas Impact Baylor University Medical Center ED-Related Costs (n=87)

$600,000 $500,000 $400,000 $300,000 $200,000 $100,000 $0

$579,270 $243,282

Total ED Related Costs

$48,331 $47,221

ED Visit Costs

$530,939 $196,061

ED Admit Costs 1 Year Before Enrollment in PAD 1 Year After Enrollment in PAD

Before & After Analysis (cont.)

Project Access Dallas Impact Baylor University Medical Center ED-Related Costs (n=87)

$8,000 $6,000

$6,658

∆ = -58%

$6,103

∆ = -63% $4,000 $2,000

$2,796

∆ = -2%

$556$543 $2,254

$0 Total ED Related Costs per Patient ED Costs per ED Admit Costs Patient per Patient 1 Year Before Enrollment in PAD 1 Year After Enrollment in PAD

Central Dallas Ministries Community Health Services

Two Population Comparison

15 10 5 0 35 30 25 20

Admission Rate (per 1,000)

Baylor University Medical Center CDM Study Population vs. 12 Zip Code Region 33 19 17 FY2005 CDM Study Population FY2006 12 Zip Code Region 48%

Two Population Comparison (cont.)

$12,000 $10,000 $8,000 $6,000 $4,000 $2,000 $0

Average Cost per Admission

Baylor University Medical Center CDM Study Population vs. 12 Zip Code Region $9,599 $9,130 $6,484 FY2005 FY2006 CDM Study Population 12 Zip Code Region 29%

Two Population Comparison (cont.)

7 6 5 4 3 2 1 0

Average Length of Stay

Baylor University Medical Center CDM Study Population vs. 12 Zip Code Region 5.82

5.69

4.62

FY2005 CDM Study Population FY2006 12 Zip Code Region 20%

Data Collection

• Provided hospital decision support staff with a roster of patients enrolled in an intervention. We provided enrollment dates for Before & After analysis.

• Requested utilization and costs for these patients for a given timeframe • Results were returned in summary format without patient identifying information

Data Collection Tips

• Ask for summary data without patient identifying information • Be prepared to produce patient consent to share health-related information

Analytical Tips

• Provide data in tabular & graphic formats • Provide aggregate data and per patient data (total costs/# of patients) • Use a static timeframe for Before & After analyses (1 yr. before/1 yr. after) • Calculate percent change – (After Costs-Before Costs)/Before Costs

Analytical Tips

Comparison population should be as similar to your population as possible – Uninsured – Demographically – Geographically – Same time period

Summary

• Impact on Hospitals can be measured by showing changes in utilization & costs • 2 primary methodologies: – Before & After analysis – Comparison of 2 populations • Next steps: documenting preventive health care services

Brent Hafele, MA

Executive Director Chippewa Valley Free Clinic 421 Graham Avenue Eau Claire, WI 54702

715-839-8477 [email protected]